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受托人的意见
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在再保险
原告: 未亡配偶
被申请人: 雇主
ROD案例编号: 84-455 – 1987年11月18日
Board of Trustees: Joseph P. 康纳斯,老., Chairman; Paul R. Dean, Trustee; William B. Jordan, Trustee; William Miller, Trustee; Donald E. 皮尔斯,小.受托人,
Pursuant to Article IX of the United Mine Workers of America (“UMWA”) 1950 Benefit Plan and Trust, and under the authority of an exemption granted by the United States Department of Labor, 受托人审查了有关根据雇主福利计划条款向未亡配偶提供健康福利的争议的事实和情况.
背景事实
The Complainant is the surviving spouse of an Employee who was killed in a mine accident on November 4, 1977 while working in a classified job for the Respondent. The Complainant is not eligible for a 未亡配偶 benefit under the 1974 Pension Plan. The Respondent provided health benefits coverage for the Complainant for 60 months following her husband’s death, 到12月31日, 1982.
被投诉人指出，根据第二条，向申诉人提供了60个月的医疗保险. E. (3)雇主福利计划规定，如果雇员在《官方网站》生效日期前去世，而其配偶没有资格获得尚存配偶的福利, 然后，应仅在配偶有资格领取分期付款的死亡抚恤金期间向未婚未亡配偶提供健康津贴. 答辩人说，申诉人有资格在雇员于11月4日死亡后分期领取60个月的死亡抚恤金, 1977; therefore, it provided health benefits coverage for the Complainant until December 31, 1982. The Respondent’s position is that no additional period of coverage is required under the 雇主 Benefit Plan.
争端
被投诉人是否负责在截至12月31日的60个月期间之后为投诉人提供医疗保险, 1982.
双方立场
投诉人的立场:被投诉人负责为投诉人提供12月31日以后的医疗保险, 1982.
Position of the 被申请人: The Complainant received health benefits coverage for 60 months, 到12月31日, 1982; no additional period of coverage is required under the Plan.
相关的规定
第二条. E. (1) of the UMWA 1974 Benefit Plan and Trust, effective 12月6日, 1974, provides:
第二条
E. 未亡配偶 and Dependents of Deceased Miners
第3条规定的健康津贴应提供给(1)任何未婚未亡配偶和(2)她在D款第(2)和(5)项中定义的未婚未亡受抚养子女, 一个死去的矿工:
(1) 在生效当日或之后，雇员在雇主的保密工作岗位上工作时发生矿难,
未亡配偶的健康福利应持续到其死亡或再婚，除非她有权根据E(4)段享受这种福利。, in which case they shall not continue beyond the period in which death benefits are being paid.
Article XX Section (c)(3) of the 1978 Wage Agreement provides in pertinent part:
(3)(i) Except as provided in (ii) below, 6月1日生效, 1978, each signatory 雇主 shall establish an Employee benefit plan to provide, implemented through an insurance carrier(s), health and other non-pension benefits for its Employees covered by this Agreement as well as pensioners, under the 1974 Pension Plan and Trust, whose last classified employment was with such 雇主.
(ii) In lieu of (i) above, 任何签署雇主可选择在本协议生效之日通过私人保险公司实施上述健康福利.
第二条. E. (1) and (3) of the 1978 雇主 Benefit Plan provide in pertinent part:
第二条-资格
E. 未亡配偶 and Dependents of Deceased Employees or Pensioners
第三条规定的健康津贴应提供给(i)任何未婚未亡配偶和(ii)此种配偶的未婚未亡受抚养子女，如D款第(2)和(5)项所界定, of an Employee or Pensioner who died:
(1) 在本计划生效之日或之后，雇员为雇主从事保密工作期间发生矿难;
(3) At a time when such Employee or Pensioner is entitled to receive health benefits pursuant to paragraph A, B, (二)本条第(三)款, 但(i)该等雇员或领取退休金者在《官方网站》生效日期前死亡，且其配偶没有资格领取未亡配偶的福利, 只有在配偶有资格根据第三条D款分期领取死亡抚恤金的期间, …
在未亡配偶(及其受抚养子女)的收入不超过200美元的任何月份，在其死亡或再婚之前，该未亡配偶(及其受抚养子女)的健康津贴应继续发放, but if such spouse is entitled to such benefits under paragraph (3) above, such health benefits will continue not longer than for the period specified in paragraph (3) above.
第二条. E. (I) of the 1981 and 1984 雇主 Benefit Plans provides:
第二条-资格
E. Surviving–Spouse and Dependents of Deceased Employees or Pensioners
第III条规定的健康福利应提供给(i)任何未婚尚存的配偶(在雇员或养老金领取者死亡之前与雇员或养老金领取者生活在一起或由其抚养)和(ii)该配偶的未婚尚存的受抚养子女，如D段第(2)和(5)项所定义, of an Employee or Pensioner who died:
(1) 在本计划生效之日或之后，雇员为雇主从事保密工作期间发生矿难;
Health benefits shall continue for a surviving spouse until remarriage of such spouse, but if such spouse is entitled to such benefits under paragraph (3) above, such health benefits will continue not longer than for the period specified in paragraph (3) above. 在未亡配偶按每月至少500美元的收入正常就业的任何月份，不得提供健康福利.
讨论
第二条. E. (1)根据1974年《皇冠搏彩中心》(“工资协议”)设立的1974年福利计划和信托皇冠搏彩中心网站向在该计划生效之日或之后因煤矿事故死亡的雇员的未婚未亡配偶提供健康福利保险, 12月6日, 1974. 该计划还规定，这种未亡配偶的医疗福利应继续给付，直到死亡或再婚为止. The Complainant’s husband died as a result of a mine accident on November 4, 1977, while working in a classified job for the Respondent. 因此, 在她丈夫死亡时，申诉人有权根据第二条E款领取健康津贴，直至死亡或再婚. 1974年福利计划, so long as her income did not exceed the earnings limitation requirements thereof.
1978年《皇冠搏彩中心》第XX条(c)(3)款要求各签署雇主制定雇员福利计划，向其雇员和领取养老金者及其合格家属提供健康和其他非养老金福利. 根据1978年工资协议建立的雇主福利计划旨在继续1974年福利计划以前提供的福利. 第二条E. 雇主福利计划(1)向因矿难死亡的雇员的未婚未亡配偶提供健康福利. Inasmuch as the Complainant is the surviving spouse of an Employee killed in a mine accident, her entitlement to benefits rests upon 第二条E. (I) of the 雇主 Benefit Plan. Reference to 第二条E. (3) of the 雇主 Benefit Plan is not applicable in this case. 相应的, 投诉人有责任为投诉人提供医疗保险，只要她未婚并继续符合第II条E款规定的资格要求. of the 雇主 Benefit Plan.
受托人的意见
The Respondent is responsible for providing health benefits coverage for the Complainant, so long as she remains unmarried and continues to satisfy the eligibility requirements set forth in 第二条E. of the 雇主 Benefit Plan.